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Upcoming changes to precertification requirements

October 1, 2014

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Effective January 1, 2015, new precertification requirements will apply to our commercial and Medicare Advantage HMO members for the medical benefit drugs listed below.

The following medical benefit drugs will be added to the precertification requirement list effective January 1, 2015:

  • BeleodaqTM (belinostat)
  • EntyvioTM (vedolizumab)
  • Keytruda® (pembrolizumab)
  • nivolumab (anti-PD-1 human monoclonal antibodies)*
  • Ruconest® (recombinant C1-esterase inhibitor)
  • SylvantTM (siltuximab)
In addition, the following medical benefit drugs will no longer require precertification approval effective January 1, 2015:
  • Aredia® (pamidronate disodium)
  • Arzerra® (ofatumumab)
  • Boniva® injection (ibandronate sodium)
  • Ceredase® (alglucerase)
  • Eloxatin® (oxaliplatin)
  • Nulojix® (belatacept)
  • Orthovisc® (high molecular weight hyaluronan)
  • Synvisc® (hylan G-F 20)
  • Synvisc-One® (hylan G-F 20)

These changes will be reflected in an updated precertification requirement list, which will be posted to the Preapproval/Precertification Requirements and Member Cost-Sharing page of our website in December, prior to these changes going into effect. Look for more information about the availability of this new precertification requirement list in the December 2014 edition of Partners in Health UpdateSM.

*Pending approval from the U.S. Food and Drug Administration.

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